Easi-Sterilise Standard Operating Procedures. Introduction & Section 1 Cleaning Procedures. Housekeeping. Fire exits Bathrooms Mobile phones Tea and coffee Respect. Why are we here?. Patient and staff safety
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Provide participants with strategies to implement the SOPs and WSAs locally by improving and standardising knowledge on:
Standard precautions are applied as a first-line approach to infection control. These form the basis for your decision-making and practice. Standard precautions are a set of guidelines based on the assumption that all blood and body fluids are potentially infectious.
In the context of sterilising practice and ALL the Standard Operating Procedures, standard precautions include:
Collection containers are:
Cleaned items must be dried prior to transport
Reusable instruments cassettes and single items placed into designated transport containers
Secure single loose items
Place heavy instruments on light instruments
Lift above shoulder height
Containers should not exceed 10 kgs
Instruments and items sorted by;
Instruments and items are checked for;
Report concerns to supervisor
Steam will not penetrate contamination left on instruments
If the item is not clean it won’t be sterilised
Manual cleaning agents
Mechanical cleaning agents
e.g ultrasonic or washer/disinfector
Drying Agents/Rinse Aids – Washer disinfectors
Acid Base Agents
Rinsing removes excess blood and debris
Heavy duty gloves & PPE
Initial Rinse - rinse instruments under warm running water
Fill sink correct ratio of warm water and suitable detergent
Identify instruments that require manual cleaning
Disassemble and open items
Inspect for damage or parts missing
Immediately notify the supervisor and contact user area
Limit the generation of aerosols
Holding item low in the sink under the water line
Apply adequate friction
Visualise item under the water line
Prevent against sharps injury and damage to the instrument
Final rinse – Rinse thoroughly under hot running water
Check that the item is clean LOOK and CHECK
Use a magnifying glass if necessary
Final rinsing facilitates the drying of item
Check no broken bristles or requires replacing
Kept free of visible debris during, after use and before reuse
Single or limited use cleaning materials
Single use, non-abrasive cleaning brushes are disposed of at the end of the day.
Reusable cleaning brushes are to be thermally disinfected at the end of the day and stored dry.
Flush, Brush and Flush all lumen items
Flush lumen with water
Wet bristles of correct size instrument brush
Pass instrument brush through the lumen and rinse debris off brush tip in an appropriate cleaning solution
Flush through with running hot water
Repeat until clean
Drying – As per manufacturer’s instructions
Disposable low-lint cloth for hose, battery and external parts
Air pressure gun (for removal of excess moisture)
Problems associated with incorrect drying
Good conditions micro-organisms multiply in 20-30 minutes
For those items that are unable to be submerged under water
The impregnated damp cloth is rubbed over the item
May need to be repeated depending extent of soiling
Handpieces that cannot be immersed in water follow the manufacturer’s instructions
Non-immersible cannulated items - the manufacturer’s instructions must be adhered to in relation to flushing and brushing
Following washing the detergent must be removed
FINAL RINSE - Using a damp clean low lint cloth (that has not been in contact with detergent), wipe over the item to remove the detergent. Note if a demineralised/reverse osmosis water system is installed, rinse with demineralised/ reverse osmosis filtered water
These steps may need to be repeated to remove all traces of detergent (Dry as per instructions in SOP 1.6 immersible item)
outside surfaces cleaned using detergent wipe,
rinsed by wiping
slow speed motors
outside surfaces cleaned using detergent wipe,
rinsed by wiping,
lubricated (manually or automatic) may need special adaptors
Dried, wrapped & processed in a wrapped cycle
Ultrasonic cleaning is a form of mechanical cleaning that uses high frequency ultrasonic waves (cavitation) that dislodges fine particles from the surfaces of instruments.
Ultrasonic cleaning is an effective cleaning method for instruments prior to the reprocessing
Follow manufacturer’s instructions
Newer models may have different requirements
Fill the tank with water
(may be cold or warm follow manufacturer’s instructions)
Then add the specified amount of detergent
Degas the water – close the lid for recommended time
Lumen instruments undergo manual cleaning first (FBF)
Initial Rinse – Rinse all items with warm water to remove gross soil before placing into designated baskets
Disassemble and open items
Place instruments in basket as per manufacturer’s instructions. Do not overload basket as ultrasonic waves will be unable to penetrate the soil on the instruments
Never place items on the floor as transducers will be damaged.
Place delicate or small pieces of items into lock down baskets
Fully submerge the items below the waterline.
Close lid and operate for recommended time
For bench top ultrasonic cleaning, use clean gloved hands
Final Rinse - Thoroughly rinse instruments with warm running water
Lumened items to have excessive moisture removed by air pressure gun or disposable syringe
Dry using a drying cabinet or with a disposable low lint cloth
EMPTYING AND CLEANING THE MACHINE
Daily and if solution becomes murky or discoloured as cleaning cannot occur in dirty solution.
Routine cleaning of the ultrasonic machine is required see
(SOP 5.9 Routine Cleaning Reprocessing Equipment)
Lumen instruments have been flushed, brushed and flushed
Use specific washer insert that is required e.g. dental handpieces
Disassembled, unlocked, opened (e.g. forceps, needle holders, scissors)
Ensure parts of disassembled instruments are together
Use disk or tags to identify instrument trays when using multiple baskets
Small/light items placed in lidded basket with hold down catch
If using barcode baskets select correct basket
Load the baskets/racks ensuring they are not overcrowded or over opened
Use a hold down screen
Hollowware is loaded in a draining position
Minimise lifting of racks
Make sure equipment stays in the parameter of the rack.
Select the appropriate cycle for the load
Cycle parameters not meeting set requirements or variations to cycle parameters – failed cycles
Items that appear dirty or stained are returned to the cleaning area for recleaning/destaining
Excess water – check the following: the machine temperature, amount of rinse aid going into the machine or the way in which the machine was loaded
Releasing the load and unloading the washer disinfector
Authorising release of the load occurs on completion of washer disinfector cycle and prior to opening the door.
Check cycle parameters have been met and print out/log (or equivalent) is signed
Care opening the doors due to heat and moisture
Inspect load not become dislodged or displaced
Avoid injury and damaging the equipment/instruments
Check for cleanliness
If machine does not dry - place into drying cabinet
Industrial dry and oil free compressed air used to remove excess moisture from lumen instruments.
Only when dry, place instruments onto designated work benches to await packing/wrapping
Stains = corrosion, pitting or other damage
Staining can occur
Occupational Health & Safety
Acid based de-staining chemicals are a strong acid and can cause burns to hands, eyes etc.
Read and follow the manufacturer’s instructions and precautions.
Refer to MSDS for first aid instructions
Only use intermittently NOT ROUTINELY
Check de-staining solution is compatible
Usually only stainless steel instruments.
Wear protective clothing + heavy duty gloves
Use a container with a good fitting lid
Strictly follow manufacturer’s instructions on water temperature, chemical ratio and exposure time
Dissimilar instruments not processed at the same time
Remove item using gloved hands
After exposure item re-washed to remove chemical residue
Only mix de-staining solution when required
Change chemical daily or more often if solution discoloured.
Remove gloves and wash hands.
Identify and report any patterns of staining
To dry the cleaned item prior to wrapping and packaging and prevent damage that occurs to the item if it is left wet.
OH & S considerations